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General NPI Number Information
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NPI Number | 1689918310
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Entity Type | Organization
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Legal Business Name | ATLANTA PAIN REHABILITATION MANAGEMENT, LLC
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 2950 STONE HOGAN RD BLDG 3 SUITE B
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City | ATLANTA
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State | GA
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Zip | 30331-2837
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Country | US
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Telephone | 404-228-2587
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Fax |
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Provider Business Mailing Address
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Address Line | 2950 STONE HOGAN ROAD CONN, BLDG 3 SUITE B
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City | ATLANTA
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State | GA
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Zip | 30331
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Country | US
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Telephone | 404-228-2587
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JACOB KOSHY
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Credential |
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Telephone | 404-228-2587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 156887
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License Number State | GA
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